Pain relief protocols

Re: Pain relief protocols

Alana Dent — Tue, 27 Mar 2012 14:00:16 GMT

Jule - your a star. This is just what I was after. And AMy - knowing they are cheaper can only help!! Now to see if the big bosses will listen, and take note.... Wish me luck!!!

Re: Pain relief protocols

Amy Homer. RVN. NCert A&CC — Mon, 26 Mar 2012 20:06:30 GMT

hi, cant remeber the doses off top of my head, but i don know that morphine/ methadone etc are so much cheaper than buprenorphine so that might persuede your bosses to chenge there protocols! lol

Re: Pain relief protocols

jules007 — Mon, 19 Mar 2012 12:26:19 GMT

Hi Alana,

We have had great success using Fentanyl patches for patients needing more 'long term' analgesia and dose them with Methadone unitl the time when we expect the fentanyl to kick in - we usually estimate 12 hours from application of the patch, but I'm sure it varies a bit. We have had no problems with this protocol and have had no issues with the cross-over period between the Methadone and the Fentanyl. The only draw back to the fantanyl patches is if they become un-stuck, but good prep of the application site usually prevents problems- nice close shave, clean the site with surgical spirit and allow to dry before applying and use the palm of your hand to apply pressure to the patch for a good couple of minutes after application. Also, just a word of warning- heat speeds up the take-up of Fentanyl so be careful if using heat pads etc.

We do use Morphine CRIs- in order to dose at 0.3mgs/kg over 4 hours, add 36mg of Morphine per LITRE of IV fluid and run at maintenance rate on a fluid pump. This is the lower dose and may need reviewing if analgesia not adequate.

If vetergesic has been administered and is not considered aqequate then an opioid can be administered on top, but will not start working until the vetergesic starts to wear off, but as soon as it leaves the mu recepetors the opioid immediately takes its place so you don;t get a 'break' in analgesia. For a long time we thought we had to wait until the Vetergesic had completely worn off before re-starting with a pure-opioid for fear of over-dosing- but apparently this is not the case and we have had no problems giving Methadone or Morphine on top of vetergesic. Obviously, if the patient is pain scored appropriately first there shouldn't be the need to do this - but we live in the real world and some vets do reach for Vetergesic as a matter of course in general practice when thinking of pain relief.

Methadone is considered by some as a superior analgesic to Morphine, but I think it depends who you talk to. The major advantage of Meth over Morph is that Meth does not cause nausea or vomiting, whereas Morphine given before pain stimulus (i.e. in a premed) is very likely to, and often does if there is pain stimulus present. Pethidine is potent but ???duration of activity about 2 hours??

Most of this information came from a vet who worked as an intern at one of the referral practices, and thankfully updated our protocols and gave us much more confidence in our approach to analgesia. I think the key is to pre-empt pain in surgical cases (in the premed) and try and pick the most appropriate analgesic to start with in emergency cases- makes life much simpler for staff and better care for the patient.

Hope this has been helpful!

Jules

Re: Pain relief protocols

Alana Dent — Sat, 17 Mar 2012 10:03:53 GMT

I will request some pain scoring sheets on monday morning.

But does any one have any protocols on meds. IE dose charts, CRI information etc.

I am pretty keen to get fentanyl patches for our orthopaedics - But no idea about the pain relief in the intrim to patch kick in? Do we stil need to use fentanyl Inj? Or can we use methadone/Morphine?

Thanks guys

Re: Pain relief protocols

Claire Bloor — Fri, 16 Mar 2012 19:58:30 GMT

I agree Ruth - pain scoring is definitely the way to go about it. We use the Colorado acute pain scales for cats and dogs (there are chronic versions too) and adjust their pain relief accordingly.

Re: Pain relief protocols

Ruth Stewart — Fri, 16 Mar 2012 15:03:08 GMT

Hi Alana,

Have you considered using pain scoring for these patients? There a several examples of pain scoring for surgical patients (The Glasgow Composite being one) Animalcare do provide a version of this for practices. You can then do a scoring with a validated pain score which can demonstrate if the patient is recieving adaquate analgesia. If the patient is showing signs of insuffucient analgesia you can show this to the veterinary surgeon and ask them to review the dosing/frequency ot type.

You can undertake the pain score as frequently as you think is necessary.

Hope this gives you some help

Ruth